Caring for Children and Adolescents With Diabetes

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"Diabetes is a deadly disease, and each year, almost 4 million people die from diabetes-related causes. Children, particularly in countries where there is limited access to diabetes care and supplies, die young". -International Diabetes Federation (IDF)

The IDF, which is an umbrella organization of over 200 member associations in more than 160 countries, leads the celebration of the World Diabetes Day, which falls on 14th November. This year the campaign is focusing its efforts on raising awareness of diabetes in children and adolescents.

Diabetes is one of the most common chronic diseases to affect children. Every day more than 200 children are diagnosed with type 1 diabetes, requiring them to take multiple daily insulin shots and to monitor the glucose level in their blood. It is increasing at a rate of 3% each year among children and rising even faster in pre-school children at a rate of 5% per year. According to IDF estimates there are over 500,000 children, under the age of 15, currently living with diabetes.

Diabetes often requires life-long monitoring, care and treatment. It will, therefore, help to know if a hospital-based approach is better than home-based care or if a mix of these two approaches is essential to meet the needs of those with diabetes.

According to Dr Sonia Kakar, a New Delhi based doctor, "hospital-based approach should be for the management of acute and/or chronic complications arising out of diabetes. But as 99% of diabetes care is self-care, empowering people with right information can make home-based care approach more feasible and economical."

"Adolescents often have the motor and cognitive skills to perform all diabetes-related tasks. Their insulin doses are determined based on blood glucose levels and food intake. Thus, they must be supervised in their diabetes tasks and allowed gradual independence with the understanding that the independence will be continued only if they adhere to the diabetes regimen and succeed in maintaining reasonable metabolic control." she adds.

"During mid-adolescence, the family and healthcare team should impress upon the teenagers the importance of checking blood glucose levels prior to driving a car to avoid hypoglycemia while driving", says Dr Kakar.

Managing diabetes in children and adolescents becomes more effective when the entire family gets involved. Families should be encouraged to share their concerns with physicians, diabetes educators, dieticians, and other healthcare providers to get help in the day-to-day management of diabetes. Extended family members, teachers, school nurses, counsellors, coaches, day-care providers, and other resources in the community can provide information, support, and guidance regarding skills to cope with the disease. They may also act as resource persons for health education, financial services, social services, mental health counselling, transportation, and home visits.

"Diabetes is stressful for both - the child as well as his/ her family. Parents should be alert for signs of depression, eating disorders or an unexplained loss of weight and seek appropriate medical help. While all parents should talk to their children about avoiding tobacco, alcohol, and other drugs, this is particularly important for parents of children with diabetes. Smoking and diabetes both increase the risk of cardiovascular diseases and those people with diabetes, who are smokers, are at an increased risk of heart/ circulatory problems than those diabetics who are non-smokers. Hence parents/ family members of children/ adolescents living with diabetes should refrain from tobacco use in order to avoid sending wrong signals to their wards" recommends Dr Anoop Misra, Director and Head, Department of Diabetes and Metabolic Diseases, Fortis Hospitals at New Delhi and Noida.

Depending on their age and level of maturity, children living with diabetes should be encouraged to take care of themselves. Most school-age children can recognize symptoms of hypoglycemia; if they are over 12 years old they may be able to take insulin injections of correct dosage by themselves. They can also be involved in planning their diet chart.

Treatment of diabetes in adolescents is complex and should only be handled by experienced physicians. Also, such patients should be looked after by a team consisting of a diabetologist, nutritionist, diabetes educator, and psychologist.

Educating people with diabetes about diet, exercise and drugs is the most important part of the initial management of the disease and should be accomplished in several sessions. Insulin management should be discussed and demonstrated to children and parents, so that they can take insulin injections themselves. Parents, along with their children, should be made aware of healthy eating habits, physical exercise, and dosage management of drugs/ insulin.

At a meeting in London, on October 25,IDF is bringing together key opinion leaders to push for action to secure care for the thousands of children with diabetes in developing countries without access to care. The meeting, 'Access to Essential Diabetes Medicines for Children in the Developing World' will focus on ways to help keep more children with diabetes alive and healthy. Ministries of Health from various developing countries, leaders from the pharmaceutical industry, philanthropic foundations, leading supply-chain management firms, diabetes associations, as well as professional societies in paediatrics and diabetes education have been invited to the meeting.

Close to 75,000 children in low-income and lower-middle income countries are living with diabetes in desperate circumstances. These children need life-saving insulin to survive. Even more children are in need of the monitoring equipment, test strips and education required to manage their diabetes in order to avoid the life-threatening complications associated with diabetes.

"We are bringing together the people and the organizations that can provide not only the interim humanitarian response to save lives but can lay the groundwork for sustainable solutions that will benefit all children with diabetes," said Dr Martin Silink, President of the International Diabetes Federation (IDF).

Article Submitted by Amit Dwivedi

(The author is a Special Correspondent to Citizen News Service (CNS).

Edited by Dr. Reeja Tharu - Medindia

Editor's Note: World Diabetes Day-2008. The theme of World Diabetes Day is - Diabetes in Children and Adolescents. This year the 'World Diabetes Day' is to be celebrated on 14th November Medindia is carrying a series of special report on this important topic. If any of the medindia member's wish to contribute, please contact editors@medindia.net.

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